Fever: a magical cancer cure

This week, I've been reading 'Farmer Buckley's Exploding Trousers and other odd events on the way to scientific discovery'. It's a popular science book from the people at New Scientist magazine and is a series of short stories (each a few pages long) about weird and wonderful and often very important scientific and technological inventions and discoveries. I'm enjoying the book, although reading a long string of disconnected stories can feel a bit laborious sometimes, but there some absolute gems amongst the collection.

One story really jumped out. On page 21 of the book, the author describes the fascinating story of Dr William Coley, an American doctor living and working in New York in the 1870's. During his work, Dr Coley stumbled upon a fascinating pattern. He treated many patients with tumours. The standard medical treatment for these tumours was to cut them out, but they invariably grew back. Coley found that patients who had tumours, but then suffered an infection that sent them into a high fever, very often were entirely cured of their tumours. For example:

The man's medical records were quite clear. His case was hopeless. In the space of three years, he had had five operations to remove a tumour from his neck. The last was a failure: it was impossible to remove the whole tumour. He would die soon. As if that wasn't bad enough, the poor man then suffered two attacks of erysipelas, a skin infection that produced a lurid red rash and a high fever. But when the fever broke and the man recovered, his tumour had vanished. Seven years later, he was still alive and well. There could be only one explanation: whatever had caused the fever had also destroyed the cancer.

Coley worked out a technique whereby he would inject a tailored bacterial mixture directly into patient's tumours with the aim of pitching them into a high fever of 40 degrees centigrade. When the fever broke, in many cases, the tumours were gone and, more importantly, never returned. He needed to choose bacteria that wouldn't harm the patient, but still stimulate a fever response. Coley often had to repeat the procedure for several months, at intervals, in order for the tumour to disappear completely. Considering the desperate medical state his patients were in, Coley's successes with this method were amazing. As Stephen Hoption Cann, an epidemiologist at the University of British Columbia stated:

'Coley had successes you couldn't even hope for today, curing even extensive metastatic disease'.

The story of Coley in the book ends with a great quote from the 17th century physician Thomas Sydenham:

'Fever is a mighty engine which Nature brings into the world for the conquest of her enemies'

But this is where things get weird. Coley's method, as the book states, was long-winded and needed to be tailored to each patient but in many cases, it worked. Chemotherapy and radiotherapy have supplanted it as the dominant method for treating cancers but as everyone knows, they're far from 100% successful and they enact a terrible toll on the patient's body. Why wasn't Coley's method pursued and refined?

In 2010, the New Scientist magazine published an article reporting on evidence that high fevers could cure patients of cancer. The article itself is a fascinating read but the letters sent in to the magazine in response to the article were equally fascinating, including this letter from Heinz-Uwe Hobohm from Giessen, Germany:

I was extremely interested in your discussion of the effects of fever (31 July, p 42). In 1996, while working in Germany on a cancer project at the University of Bremen, I stumbled on a 1951 paper by Louis Diamond and Leonard Luhby on spontaneous remission in childhood leukaemia (Journal of American Medicine, vol 10, p 238). They noted that a feverish infection preceded remission in 21 out of 26 children they studied. I remember jumping up from my chair thinking this cannot be happenstance. I investigated many publications on spontaneous regression from cancer. Many, if not a majority, of cases were preceded by a feverish infection - see my 2005 paper in the British Journal of Cancer (vol 92, p 421). Today we know that bacterial and viral chemicals such as lipopolysaccharides, which are strong inducers of fever, are needed to activate innate immune system - the body's initial immune response which defends against pathogens in a general way without conferring immunity - and that this activation is needed to trigger a full-blown T-cell response against cancer cells. Yet whenever I present these findings in medical circles, the reaction is blunt mistrust. For example, at a recent conference on innate immunity I listened to a talk that revealed that many more patients survive sepsis, a whole-body inflammatory response, if they develop fever. I asked whether it might be worth considering inducing fever in high-risk patients. I received a brief response: “No".

Another new scientist letter on this subject, from William Hughes-Games in Waipara, New Zealand, made a worrying, but valid point:

The trouble with using fever as a cancer cure is that it would not be patentable. It would be a repeat of the malaria-wormwood story: progress in the widespread use of artemisinin - the anti-malaria agent derived from wormwood - was stymied for many years by the lack of obvious profitability.

Where do we go from here? Clearly, you can't do Coley's treatment at home if you have a serious cancer. It requires a trained medical practitioner to carry out a course of injections of bacteria tailored to you over a period of months. But I think the widespread negativity towards Coley's method amongst the medical and scientific establishment is a big problem. A cynical person would agree with Mr Hughes-Games from New Zealand; Coley's method ate up a lot of doctor's time and no one sold any patented pharmaceuticals or expensive equipment that way.

There is another angle, one of culpability and accountability. If a doctor injects a cancer sufferer with a bacteria to create a fever and the patient dies, the patient's family could easily sue the doctor for vast sums of money and possibly have him struck off, even though 95% of his fever treatments were a success for cancers that normally kill, say, 30% of their hosts. If the doctor instead puts the patient on a course of chemotherapy or radiotherapy, those treatments may only succeed at a significantly lower rate than the fever-cure but the doctor is safe from accusations of manslaughter or malpractice. In this situation, chemotherapy or radiotherapy may be the worse option for the patient, but it's the safe option for the doctor's career.

Perhaps in another century-or-so, our medical culture, both in terms of doctors and patients, will be very different; here's hoping.